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This chapter is not intended as a comprehensive account of all the neurosurgical procedures for pain; rather it is intended to explain the rationale of neurosurgery for pain, and illustrate some of its potential. One of the most important roles of a neurosurgeon involved in surgery for pain is to be certain that surgically remediable pathology has not been missed – in the case of ‘chronic’ sciatica this may be a simple lumbar disc prolapse – more rarely ‘trigeminal neuralgia’ may represent the facial pain from an acoustic or even trigeminal schwannoma. As far as specialist pain clinic practice is concerned, procedures may involve quite specialized techniques drawn from different areas of neurosurgery such as spinal neurosurgery or stereotactic and image-guided techniques. The ‘pain’ neurosurgeon thus requires considerable general and specialist expertise. A fully equipped neurosurgical facility is of course required, with facilities for intraoperative neurophysiological monitoring.